Reports From the Field

Evaluation of a Diabetes Care Coordination Program for African-American Women Living in Public Housing

Journal of Clinical Outcomes Management. 2015 August;22(8)

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Ambassadors were a part of all the course and support group sessions, and when needed they attended indivdual sessions, such as doctor visits and meetings with the high-risk nurse case manager. Ambassadors accompanied program participants during visits with clinical staff to provide additional support when requested.

The manager of quality assurance assured the safety of intervention procedures and employed performance improvement methods. Program participants provided informed consent, and had the right to withdraw at any time. The Quality Assurance Committee at WSHC protected the rights of participants, assured the safety of intervention procedures, and assured the quality of care received by each participant.

Evaluation

The Work Group for Community Health and Development at the University of Kansas was selected by the BMS Foundation to evaluate the implementation and related clinical outcomes of the program using a participatory evaluation framework [16–18]. A similarly funded study used the same study approach [19]. Clinical health outcomes were analyzed through a pre-post test comparison using STATA Version 12. Paired t tests were used to examine within-patient health outcome changes. The mean interval between the pre and post measurements was 16 months. A 0.05 level of significance was used. Using a one-sided t test, Cohen’s d was computed to measure effect size.

Results

Services

In January 2012, we began recruiting Ambassadors and providing DCCP services based on a rolling enrollment. Overall, WSHC documented 71 distinct services provided over the project period ( Figure 2 ).

Clinical Outcomes

Of the 175 women who were recruited and enrolled into the DCCP, 148 participants completed at least 80% of the DSME classes and were included in the pre-post clinical outcomes evaluation. Data collection for 7 diabetes-related clinical health outcomes was completed at baseline and following the intervention. Measures were 1) body mass index; 2) weight 3) systolic blood pressure; 4) diastolic blood pressure; 5) HbA1c; 6) LDL cholesterol; and 7) overall cholesterol. The results showed small improvements in HbA1c, weight, and diastolic blood pressure. There was a change in mean HbA1c levels from 7.76% to 7.48% ( P = 0.016). The average weight of patients at baseline was 199.9 pounds, whereas at 16 months patients averaged 197 pounds ( P = 0.021). Diastolic blood pressure was reduced from 82.9 mm Hg at baseline to 80.7 mm Hg in the post assessment, a 2.2-point change ( P = 0.027). Other clinical health outcomes showed smaller changes (BMI, systolic blood pressure, LDL cholesterol, and total cholesterol). Additionally, using a one-sided t test, Cohen’s d was computed to measure effect size. For HbA1c, weight, and diastolic blood pressure, the effect sizes were approaching medium. Table 2 summarizes the results for DCCP clinical health outcome measures.

Discussion

This empirical case study examined the implementation of the Diabetes Care Coordination Program (DCCP) and its effects on diabetes-related clinical health outcomes for program participants. The program’ glucose screenings and educational workshops at public housing units provided enhanced access to diabetes care services for community members. Referrals to WSHC allowed for the provision of clinical health services through a comprehensive care model. Modest improvements in diabetes-related clinical health indicators were seen.